As I mentioned in Part One, much of the focus on DJT has been on whether he meets the diagnostic criteria for Narcissistic Personality Disorder. Allen Francis, who helped write the personality disorder criteria, has expressed many times that DJT is “bad, not mad.” His reasoning is that DJT’s narcissistic traits don’t cause Trump personal distress and haven’t adversely affected his functioning; in fact, DJT was elected president! In diagnostic terminology, Dr. Frances is saying that DJT doesn’t meet either the distress or impairment criteria, at least one of which is needed to make a formal diagnosis.

Despite the objections of Dr. Francis, if you look at the DSM-5 criteria for NPD, it’s easy to see that DJT’s public behaviors could have served as the prototype for the DSM’s authors as they developed the NPD diagnostic criteria. But it still doesn’t mean DJT has NPD. In addition to not meeting…

Note — This is a three or four part series focusing on complexities of psychiatric diagnosis; then I ramble into an exploration of what specific psychological and interpersonal dynamics might be driving Donald Trump’s behaviors. This piece and the next two or three are a lead-up to an essay I’m doing for Slate Magazine.

Psychiatric diagnosis looks easy.

All you need is a diagnostic manual. In the U.S., you can use the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; published by the American Psychiatric Association) or the 10th edition of the International Classification of Diseases (ICD-10; published by the World Health Organization). Even easier, you can search for and find online diagnostic criteria for virtually every mental disorder. The power to diagnose is at your fingertips.

If you think your friend has panic disorder, you can type “panic disorder”…

A long, long time ago, the Grand Old Party stood for family values, moral values, and apple pie. Now, with Trump as leader, it’s more like family torture, infidelity, and borscht.

Less long ago (Thursday, May 31, 2018), former House Speaker John Boehner quipped: “The Republican Party is kinda taking a nap somewhere.” Boehner was drinking a bloody Mary at the time, so maybe we shouldn’t blame him for not noticing that his former party’s nap has lasted nearly two years.

The GOP was mortally wounded on a Super Tuesday back in September, 2016. In seven states, the Party of Lincoln voted to nominate Donald Trump for President. Sure, “Lying Ted” won a couple states and a few #NeverTrump folks were hanging on, but the die was…

As a psychologist interested in ethics, Dr. Bossypants spends many hours contemplating the human condition. Lately, she’s been fascinated with the facile ascent of fake news and the apparent gullibility and complicity of humans in this phenomenon. Here is the first of perhaps many speculations.

From time immemorial, humans have needed each other to survive. Even rugged individualists and extreme preppers benefit from the collective creativity of the human species. And generally, we don’t want to hang out with just any old Jane Doe or Joe Blow. We seek people who more or less value and agree with us. Usually, outliers start suspecting there’s something wrong with them, and soon enough, there will be. Completely isolated people suffer, and most break down over time.

Within the context of community, humans have a lot of other needs. For example, there are needs for power and control, prestige, order, safety, excitement, love, nourishment, offspring, humor, and attention. There are needs to contribute positively to society, and needs to protect yourself and those you love. This is not an exhaustive list. Some argue that these needs can all be traced back to the urge nature imbedded in us to propagate our genes. Maybe. But like many of our basic animal urges, we must refine, redirect, balance, and sometimes overcome these urges with consciousness, compassion, courage, reason, and love. Nature has no problem with animals dropping their pants and pooping wherever and whenever this natural and necessary need strikes, but I’m a big fan of outhouses and collective expressions of self-control in this domain. The taming of fire as an evolutionary step forward is rivaled in importance by the invention of the diaper. Indoor plumbing came much later, but again, an impressive leap for humankind.

Fake news is tempting for many reasons. As we’ve noted, humans like to feel like they belong. They hang with their homies, even in the face of evidence that their homies might be bad dudes. And humans greatly enjoy being right. Most parents have noticed that the shorter, less mature among us will argue well past the point of absurdity to hold on to a false belief that benefits them. For instance, the possibility of global warming is quite inconvenient. Therefore, the easy route is to simply deny it.

Fake news is generated for financial and political reasons. Fake news is certainly not our best attempt to explain the world or keep ourselves informed. Mature, moral humans can distinguish between fact and propaganda, between rumors and explanations. We have the means and the abilities, but we often lack the will.

So here’s one possible conclusion Dr. Bossypants endorses: Fake news is successful because of moral incontinence. Yes–giving into the temptation to cut corners and indulge in what Freud might have called leakage of the Id.

Aristotle believed humans were prone to moral incontinence when it came to money or self-aggrandizing. And of course, anger. Think about it: When you let yourself get crazy angry, you might say or do things you aren’t proud of later. Similarly, when we let ourselves want to be right at all costs, we gobble up bot-driven absurdities to bolster our beliefs. Sadly, the more frequently and loudly lies are repeated, the more likely they are to be believed. It’s Groupthink on steroids. Generating, promoting, and sharing highly suspicious “facts” in order to reassure our inward little self, be popular, or sell ads is the equivalent of taking a moral dump in a crowded room.

Diaper-up, people. These compelling human needs (to belong, be right, be rich, etc.) set us up for trouble when paired with immaturity and laziness. Sure, it’s thrilling to contribute to massive conspiracy theories. It’s easier to believe than check the facts. It’s also easier to fear, cheer, and jeer than reason, research, and admit being wrong. But easier isn’t better. In fact, sometimes it’s a public health hazard, and pretty much always, it stinks. Of course, there will be people willing to tell you it doesn’t, but trust me on this one folks, it reeks.

Being human, we’re accustomed to eating contradictions for breakfast. Even if we eat little else. We intend to behave quite a bit better than we usually do, and we squabble over what it means to be moral, or to live a good, fulfilling, worthy life.

Even if we agree on a moral rule, or make a law, we might observe the rule or obey the law for radically different reasons, or break the law for reasons we believe to be moral. Yes, indeed, dear readers. Dr. Bossypants knows it’s difficult to sort this all out, even though she has tried mightily to blog about morality and ethics in a most intriguing and approachable manner. Now, we have one more lens through which we might view moral decision-making, and then a bit of a summary, so those of you determined to put these ethical thoughts into ethical actions might do so. Right away. Please.

In the late 1970s, bioethics became a recognized specialty as hospitals and healthcare providers grappled with ethical decision-making in the increasingly contentious, conflicted, expensive world of healthcare.

Tom Beauchamp and James Childress identified four guiding principles in the first edition of their influential book Principles of Biomedical Ethics:

Autonomy (Human beings should have authority over decisions affecting their health and well-being.)

Beneficence (Decisions should be made on the basis of doing good and being of help to others.)

Nonmaleficence (People should strive to do no unjustified harm.)

Justice (All people should be treated equally and benefits and burdens should be distributed fairly.)

Principles don’t offer concrete answers, but provide a framework to begin the hard work of ethical decision-making in the face of competing needs and limited resources.

Robert Bellah said “Cultures are dramatic conversations about things that matter to their participants.”

Listen, dear readers. Right now, we are engaged in a monumental conversation in our culture. We’re talking health care. Is it a basic human right? If so, how much health care should we make available in a world of apparently limited resources? Who should profit in the provision of health care, and how much profit is justified? Who should pay, and how should that duty be distributed?

Should we provide abortions to those who do not wish to be pregnant? Should we provide viagra to those who wish to have a pharmaceutically-assisted erection? Should we provide a means by which someone suffering, or near death, could choose to die with medical assistance? Oh, the inflammatory and politically-loaded questions just go on and on. They require deep thought. They require wisdom. These matters are seething with ethical quandaries.

Kant reminds us we should never treat people as a means to an end, nor deny anyone rights we would wish for ourselves.

John Stuart Mill reminds us we should choose paths, practices, and laws that insure the greatest possible good (health) for the greatest number.

Aristotle urges us to find the golden mean, the balancing point between excesses. And to be generous, courageous, and prudent.

Feminists remind us of the huge, destructive problems that arise when power is used to abuse others, to deny basic rights, and to enrich the already-rich.

Those who practice relationship-inclusive ethics remind us that we must always consider the direct impact of our actions–and our goal should be to take the most compassionate action possible.

The bioethicists offer us principles to consider, though admittedly these principles might actually conflict with each other sometimes.

We do not live in a perfect world. It is our job to make it better, not to give up in anger or despair. The ability to reason, converse, and find common ground is a human attribute we should treasure. Courage, dear ones. Be good people.

Let’s face it folks. We live in a broken world. Let’s not get into who broke it, but we can all pretty much agree things are far from ideal, or perfect, or even as good as they could be. So how do we make it better? We ask ourselves the question made famous by Jeremy Bentham and his protege (and admirably early feminist) John Stuart Mill, the forefathers of Utilitarian Ethics. The question is this: What action will bring about the greatest good for the most people? This approach is also known as consequentialist or teleological ethics–the focus is on the outcome of an action. It is a good, or moral, action if it beings about the most good possible for the most people.

Englishman, Jeremy Bentham (1748-1832), believed that pleasure or happiness was the “substance” that should be measured in this equation. To evaluate the moral merits of one action over another action, you assess how many people would be made happy, or be given pleasure by each action. Bentham wrote, “Nature has placed mankind under the governance of two sovereign masters, pain and pleasure. It is for them alone to point out what we ought to do…”

Bentham’s thinking was heavily influenced by the enormous social upheaval that gripped 18th century England. He witnessed tremendous affliction all around him and sought a basis for morality that was both practical and social in nature. Bentham’s claim was that all acts and institutions must justify themselves by their utility—hence, the label “utilitarian.”

John Stuart Mill (1806-1873) was Jeremy Bentham’s godson and Bentham was a close friend of the Mill family. Though in basic agreement, as Mill developed his thinking, he came to believe that Bentham was wrong on one important point. Bentham believed that any kind of happiness was of the same value as any other kind of happiness. Mill argued that some forms of human pleasure was of higher quality than others, and therefore worth more in the utilitarian equation. He argued for the betterment of all humankind.

People are social beings. We tend to want to be in harmony with our fellow human beings. Mill believed that at our core, people want the best for each other and are inclined to promote the common good. Wouldn’t it be nice if he was right about this??

Modern day utilitarians no longer try to quantify or qualify pleasure in a specific equation. They simply assert that morality is based on finding outcomes that will increase the common good, and decrease human suffering.

In contrast to deontological approaches (see the DUTY blog), utilitarians abandon any claim to moral certainty, because as I noted at the beginning, we live in an imperfect and fluid world. How could anyone assume moral certitude in an uncertain world? The best we can hope for is finding the greatest balance of good over evil in a world that has no perfection, no absolute goodness.

Many social reform movements can be seen as expressions of broadly-defined utilitarian thinking. The welfare of the weak and disenfranchised members of society is counted as having equal weight and import in the overall fabric of society. For instance, John Stuart Mill along with his wife, Harriet Taylor, was an early and articulate advocate for equal rights for women.

He wrote “…the principle which regulates the existing social relations between the two sexes—the legal subordination of one sex to the other—is wrong in itself, and now one of the chief hindrances to human improvement; and it ought to be replaced by a principle of perfect equality, admitting no power or privilege on the one side, nor disability on the other.”

Democracy, as a form of government, could also be seen as an expression of utilitarian orientation. Robert Bellah and his co-authors have pointed out that the right to vote in a democracy is one in which we ask the individual to assess and support the common good. If a politician makes decisions based only on personal gain, we consider that politician corrupt (or at least, we used to…). This is equally true of the voter who votes not for the common good, but for their own personal gain. As moral citizens in a democracy, we are charged to evaluate and support what is best for the whole community.

In summary, utilitarian morality requires that we consider the outcome of our actions, and act to bring about the greatest good for the greatest number of people. It is immoral not to do so. This requires us to go beyond our own desires and preferences, and act in ways likely to enhance the lives of everyone around us, close by and far-flung. We are increasingly connected globally as a human community. floating along on our little blue earth. The moral challenge, to consider the common good, has never been more complicated, nor has ever been more crucial.

Why, oh why is Dr. Bossypants yammering on about morality…?? Three posts already, and more to come. Ugh. It can be SO boring. Yes. True. Boring. And vital. Do you want to survive as a species or not? Well. Then…

Onward in our journey through the land of morality. Someday, maybe soon, you’ll use this blog to scold or defend yourself. It will all be worth it. Today, we’re looking at morality through a lens called Deontological Ethics, a lens provided by Immanuel Kant (1724-1804).

Kant was the original “just do it” moral philosopher. Regardless of how one feels about it, and regardless of outcome, there are moral duties that are applicable at all times and in all places. Some actions are morally wrong, no matter where or when they are enacted, and some are right. No weasel clauses allowed.

Kant also understood that we are mere mortals, incapable of always doing the right thing. He insisted that we at least be aware of when we are failing. For example, Kant argues that lying always causes some damage, even if that damage is no more than the liar knowing that he is choosing to do something wrong. But Kant also knew that people lie. He did not expect humans to completely stop lying, but he did urge people to consciously admit that they weren’t making a moral choice. For Kant, lying was never, under any circumstances, morally correct.

Of course, the big question is this: How do we know which actions qualify as always morally correct? Kant came up with a guide for judging moral actions. He called it the Categorical Imperative–the ultimate yardstick for checking the morality of the action. One of his formulations of the categorical imperative is this:

So act that you could will your action to be a universal law for all humankind. This is very similar to Jesus’s instruction: Do unto others as you would have them do unto you. Or remember when your parents said, “Now how would you like it if everybody acted like you’re acting?”

Another take on this imperative is this: So act as to treat humanity, whether yourself or another person, as an end-in-itself, never as a means only.

Kant argued that even though there will be compelling practical or emotional factors in a given situation, it is our duty to consider the action through the lens of “always, everywhere, for everyone.” Regardless of the circumstances, and regardless of the outcome, there are moral actions that are always right or always wrong.

Kant also believed that ethical principles apply to anyone capable of deliberation and reason. He believed there were three ways rational beings could interact with their duty, but only one would yield moral behavior.

They could act in ways that are clearly bad: actions such as lying, cheating, stealing, or torturing people.

They could act dutifully, but only for the show of it. Not because it is simply the right thing to do.

They could act from, or because of their duty–doing the right thing for the right reasons.

Only the third is a genuinely moral action. If you do the right thing for the right motives, then you have acted morally. In fact, the less benefit you derive from doing your duty, and the less you actually want to do it, the more you can be sure your action is truly moral.

So, to sum up this stern Kantian input: You cannot use other people as a means to your own end. You must always evaluate your actions and act in ways that you would want everyone to act, in all times and in all places. An you simply cannot make yourself an exception to the rule.